PENNSYLVANIA BAR ASSOCIATION

Award for Outstanding Leadership in Diversity and Inclusion
(Related to Membership, Leadership Initiatives, and Other Diversity and Inclusion Efforts)

Nomination Form

1. PBA Entity (e.g., Pennsylvania Bar Institute, Pennsylvania Bar Foundation, Pennsylvania Bar Insurance Fund and Trust, Conference of County Bar Leaders, Board of Governors, House of Delegates, Committee, Section, Commission Team, Task Force, Institute-for example, Bar Leadership Institute)
   


2. Brief description of effort, contribution, service, or program including dates.
   


3. Describe how program assists in furtherance of the PBA Diversity and Strategic Plan (refer to award criteria in Request for Nominations).
   


4. List any other factor(s) that you believe would assist the Awards Committee in evaluating the nomination.
   


5. Contact Person.

   Name:
   Address:
   Email:
   Phone Number: